Medicaid Waiver

Your questions answered.

Medicaid Waiver: Answering Your Biggest Questions

When you’re trying to find a new home for your family member with an intellectual or developmental disability, you’ll likely hear one thing: You need to be on the Medicaid Waiver. The waiver affects where your family member can live and what services they can use. The hard part is learning everything about the waiver, applying for it, and most importantly, getting onto it. 

To help get your family member the services they need, here are some frequently asked questions about the waiver so you can access services as soon as possible. 

Frequently Asked Questions

What is the Medicaid Waiver?

Put simply, the Medicaid Waiver allows people with intellectual and developmental disabilities to live on their own. You allow them to live in a community home, which waives them from living in an institution.   

“The Medicaid Waiver is the difference maker,” one parent who’s used waiver services said. “When you are no longer around, your child will still have a place to live and people to care for them.” 

Some programs may be funded by your county, but the waiver is funded by the Virginia General Assembly. Many Gabriel Homes residents are on the Medicaid Waiver because they can access more services and programs. However, families have a hard time getting onto the waiver because there is a long waitlist of people looking to receive services. 

How do I get from the waitlist to the waiver?

Your support coordinator should have already placed your family on the waitlist. If you don’t have a support coordinator, contact your local Community Services Board (CSB). 

When you meet with your support coordinator, ask for your priority status and share changes in your needs. You must aim for your family member to be in the priority one bracket, meaning you need services within a month, to get waiver services as quickly as possible. Keep asking your coordinator to reevaluate your family member and advocating to be priority one. 

The Virginia Department of Behavioral Health and Developmental Services has more information on getting onto the waitlist and reviewing your priority. 

I’ve been priority one for a while, but I’m still not on the waiver. What can I do?

Unfortunately, you just have to wait. Some families wait for months, if not years. 

One way you can get involved is through the Arc of Virginia, who can help you set up appointments to meet with your state legislator. One of the Arc’s top policy goals is increasing the waiver’s budget so more families can use services. See how you can get involved with your lawmakers at thearcofva.org. 

On top of getting involved, be proactive with your support coordinator and keep checking on your family member’s status. Coordinators usually have large caseloads, so make it your priority to follow up with them. Once you’re off the waitlist, then you can work with your coordinator to pick the provider that works best for your family member. 

 

What should I keep in mind when I’m looking at housing options?

There may be no such thing as your perfect home. You might have to compromise. Maybe the location is too far from work, or the bathrooms are not wheelchair accessible. But maybe there’s a home where your family member gets along well with the housemates and it’s in a safer area. 

“If there’s one thing you should always keep in mind when you’re looking for a home,” one parent said, “it’s to think of your family member’s best interests and ask the questions they would want asked for them.” 

My Life, My Community is a great place to start when you are looking for homes near you and services for your family member. 

 

How do I make sure I don’t get taken off the waiver?

You will always have your waiver once you are off the waitlist, but keep track of three things: 

  1. Your service providers work on individual service plans (ISPs) with your family member. ISPs will help them track personal. All your service providers will provide you quarterly updates on your family member’s progress and if their needs change. Keep an eye on your providers and ISPs to make sure they benefit your family member. 
     
  1. Your family member must have less than $2,000 in assets to receive benefits. The limits are in place because the waiver is a needs-based program. Since $2,000 is hard to live on, one workaround is to open Achieving a Better Life (ABLE) accounts and special needs trusts. Both accounts let you be a trustee so you can manage your family member’s other financial needs. 
     
    The Arc of Northern Virginia has many resources that show how you set up your trust account. 
     
  2. You must fill out renewal applications every year to show that you are eligible for waiver benefits. Thearcofnova.org also has tips on how to make your renewal process a breeze. 

Where can I get more information on the waiver?

Two videos by the Arc of Northern Virginia can help you master the Medicaid Waiver. The first video explains what to do if you’ve been awarded a waiver, and the second goes over the waiver’s basics, including services and financial needs. 

Thearcofva.org also explains the waiver types and which best suits your family.